Ineedhopenow

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I'm trying to better understand these fields. What are the advantages and disadvantages of these fields. For example:

FM:

- Can open a practice without having to do a fellowship
- Wide range of patience and all ages
- Can work in hospitals (where in the hospitals do they work?)

IM (without fellowship)

- Can specialize
- Only work with adults
- Deal with more complicated diseases of the organs
- Can't open a practice without specialization (am I wrong?)
- Can work in hospitals (I think they take care of patients that are hospitalized or have been stabilized by the ER docs.)

I realize my understanding between these two fields is poor. Could someone add to the list and correct my misunderstandings?

Thanks in advance!
 

theseeker4

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I'm trying to better understand these fields. What are the advantages and disadvantages of these fields. For example:

FM:

- Can open a practice without having to do a fellowship
- Wide range of patience and all ages
- Can work in hospitals (where in the hospitals do they work?)

IM (without fellowship)

- Can specialize
- Only work with adults
- Deal with more complicated diseases of the organs
- Can't open a practice without specialization (am I wrong?)
- Can work in hospitals (I think they take care of patients that are hospitalized or have been stabilized by the ER docs.)

I realize my understanding between these two fields is poor. Could someone add to the list and correct my misunderstandings?

Thanks in advance!
This is incorrect in that internal medicine physicians can open general practice primary care offices, much like family medicine doctors but without the OB/GYN aspect or peds. I don't believe a fellowship is required to do this in most states, but I could be incorrect..:confused:
 

Ineedhopenow

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I feel like internal medicine (without a fellowship) is like family practice but restricted to adults and to working in hospitals.

Please correct me :)
 
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JESSFALLING

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I feel like internal medicine (without a fellowship) is like family practice but restricted to adults and to working in hospitals.

Please correct me :)

IM docs typically have more inpatient experience, which is why many of them go on to work as hospitalists. However, there are no restrictions as to where they can work. In fact, all physicians are generally licensed in medicine and surgery; they just limit their practice to those areas that they have experience in.

If you want a broad-based outpatient practice, FM is a good choice. In rural areas, you'll also see a higher prevalence of FM docs practicing OB, hospital medicine, and aspects of general surgery, though the later is certainly not as common these days.

If you dislike Peds and OB, and/or want to further specialize, then IM is a great way to go. You could also explore the possibility of a combined Peds/IM residency if you find that you enjoy treating both kids and adults, yet still desire to specialize.

Lastly, you may enjoy the book "Caring for the Country". It's all about FM in a rural environment.
 
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TheMightySmiter

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I feel like internal medicine (without a fellowship) is like family practice but restricted to adults and to working in hospitals.

Please correct me :)

Lots of primary care docs are IM and not FP. You certainly can be a hospitalist as an IM doc, but I believe most have private practices. You do not have to specialize, though many do. Some examples of IM fellowships are cardiology, gastroenterology, critical care, hemetology/oncology.
 

mvenus929

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I feel like internal medicine (without a fellowship) is like family practice but restricted to adults and to working in hospitals.

Please correct me :)

You are incorrect. There are even primary care tracks for internal medicine, if all you want to do is work in an outpatient clinic. You can also specialize in geriatrics and still have only an outpatient clinic and be working primary care... you'd just only see older adults.
 

LizzyM

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Family medicine takes care of people of all ages including babies and children, pregnant women, adults, and the elderly.

Internal medicine is limited to the care of adults (including the elderly).

Internists (a person trained in internal medicine) has some training in the diagnosis and treatment of common medical conditions such as allergies, arthritis, hypertension, diabetes, infections, overactive and underactive thyroid, acid reflux and stomach ulcers, depression, some gynecologic issues (including oral contraceptives) and the provision of preventive services such as immunizations, counseling on smoking cessation, and the ordering of screening tests for cancer. The challenge is knowing when to treat and when to refer a patient to a specialist (someone who has done a fellowship and who has more training and experience in a single area of medicine such as cardiology or oncology).

There was a time when most physicians cared for patients in the office (out patient setting, "the doctor's office") and also saw the same patients when they needed hospital care. Things are changing and now more hospital-based care is provided by "hospitalists" who limit their services to the treatment of patients in the hospital (or who need pre-operative medical clearance as out patients) which is more efficient (the doctor doesn't have to run back & forth from the hosptial to the office twice each day and field phone calls from the nurses in the evening and overnight) but it does leave physicians feeling like they lose track of their patient during the hospitalization. On the other hand, patients are not hospitalized as much as they were 30 years ago and there is more care being delivered at home (IV antibiotics, for example, and wound care) that would have been done in the hospital a generation ago.

An internist usually cares for patients on a "medicine" floor or in the Intensive Care Unit (although that care is usually delivered by a specialist in Critical Care Medicine). Some of the common reasons for being admitted to a medicine floor might include pneumonia, liver failure, serious infections, heart failure, heart attack (after acute treatment is finished). In places where family medicine docs are common (no where I've ever lived) the Family Medicine physicians might take care of adults with the same ailments that internists see in the hospital. I doubt Family Medicine docs treat many hospitalized kids as anything bad enough to send a kid to the hospital overnight is likely to be handled by a pediatric subspecialist.


Understanding how all this works is one good reason to shadow physicians in a few different areas of medicine before starting medical school and then getting additional exposure during the first 3 years of medical school at which point one makes a decision about residency training.
 
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Knocked Up

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Family Medicine:

~1300 matches
average board score of those who matched last year: 213
average board score of those who didn't match last year: 202

To put this in perspective the average Step 1 score is usually around 225 nationally

Internal Medicine:

~3000 matches
average board score of those who matched last year: 226
average board score of those who didn't match last year: 210
~350 people applied with board scores over 240

high board score + honors in medicine + possible away rotation = nice match = better position for fellowship

Hope this helps!
 

JESSFALLING

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Family Medicine:

~1300 matches
average board score of those who matched last year: 213
average board score of those who didn't match last year: 202

To put this in perspective the average Step 1 score is usually around 225 nationally

Internal Medicine:

~3000 matches
average board score of those who matched last year: 226
average board score of those who didn't match last year: 210
~350 people applied with board scores over 240

high board score + honors in medicine + possible away rotation = nice match = better position for fellowship

Hope this helps!

The fact that FM isn't a competitive field should not be the immediate concern to the OP. Fitness with one's personality and interests is the paramount concern, especially as a premed. There are many FM residents (with competitive board scores) on this board and elsewhere that chose the FM because it was the ideal career for them. Personally, I think it's a compelling notion to be a rural family doctor....but my first choice right now is psych....:love:
 

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fitting with personality should be a high concern, unless you got a 200 on step 1 and your personality is Derm all the way
 

Ineedhopenow

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Family Medicine:

~1300 matches
average board score of those who matched last year: 213
average board score of those who didn't match last year: 202

To put this in perspective the average Step 1 score is usually around 225 nationally

Internal Medicine:

~3000 matches
average board score of those who matched last year: 226
average board score of those who didn't match last year: 210
~350 people applied with board scores over 240

high board score + honors in medicine + possible away rotation = nice match = better position for fellowship

Hope this helps!

Thanks for the info Knocked up. After taking money out of the equation, I just can't see myself specializing. I find doing a few set of procedures really well to be monotonous. I really like looking at the big picture when dealing with problems, that's why I think primary care is a field I'd be happier in. It's unfortunate there's such a salary gap, but I figured I'd just work more hours if I needed more money to pay off loans.

Thanks everyone! LizzyM, that was a great answer.
 

elblackwell

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Thanks for the info Knocked up. After taking money out of the equation, I just can't see myself specializing. I find doing a few set of procedures really well to be monotonous. I really like looking at the big picture when dealing with problems, that's why I think primary care is a field I'd be happier in. It's unfortunate there's such a salary gap, but I figured I'd just work more hours if I needed more money to pay off loans.

Thanks everyone! LizzyM, that was a great answer.

If you really think you won't specialize, you should look into the scholarship offered to students like you where they pay your tuition and give you a stipend; you are then obligated to work in a primary care position for a certain number of years. Also, there are certain places that offer loan repayment programs for primary care physicians.
 

tantacles

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Thanks for the info Knocked up. After taking money out of the equation, I just can't see myself specializing. I find doing a few set of procedures really well to be monotonous. I really like looking at the big picture when dealing with problems, that's why I think primary care is a field I'd be happier in. It's unfortunate there's such a salary gap, but I figured I'd just work more hours if I needed more money to pay off loans.

Thanks everyone! LizzyM, that was a great answer.

Keep in mind that not all fellowships are monotonous. In many of them, you deal with a variety of problems, all of which have different solutions.
 

LizzyM

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Keep in mind that not all fellowships are monotonous. In many of them, you deal with a variety of problems, all of which have different solutions.
I agree! Endocrinology covers so many different disorders including hormones produced by the pituitary, thyroid, parathyroid, pancreas, adrenal glands, ovaries, testes. Rheumatology covers arthritis (several different kinds) but also lupus, gout, and infectious diseases that settle in the joints. Cardiology even has subspecialists as cardiologists handle the heart muscle, the circulatory system that serves that muscle, the valves within the heart and the electrical conduction system of the heart. Then there is cardiac output (blood pressure), and preventive cardiology (treatment of hypertension and high blood lipid levels). That a fellowship takes 3 years should tell you that there is much to learn and new things coming along all the time to keep up in a specialty.
 

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I remember debating between family medicine and IM/Peds before going to residency in family medicine. Here's what I've learned over the years:

Full-spectrum family medicine (peds, OB, office procedures, inpatient) is becoming increasingly rare. To get a lot of peds patients, you need to do OB. To do OB, you need to do a large volume or be in a group/academic practice. I've only really seen full-spectrum family medicine in rural areas and in the military.

Urban/suburban family medicine and internal medicine clinics tend to look the same. Most of the women of childbearing age and children go to OB/GYNs and Peds.

Most docs who go into IM/Peds usually end up doing one of the other. Groups of IM/Peds docs are increasing which may make this less so in the future.

Both family docs and internists admit patients to the hospital. There usually isn't a difference in type of patient or disease complexity. Both internists and family docs, however, are turning more and more to hospitalists for inpatient care. Most hospitalists are internists.

If you want to work in an Urgent Care or ER, family medicine is better as you get the training and experience working with pregnant women.

There are a lot of bad docs out there, and family medicine has a decent number of them. Since there is such a shortage of primary care docs, family medicine tend to take those with lower scores to fill residency slots. IM tends to have higher board score because those students want to specialize. It is very easy to be a bad doc and refer most of your patients to specialists. Being a really good or great family doctor is one of the hardest things to do in medicine. A transplant surgeon I worked with said he felt it was the most difficult. You constantly have to shift mindsets from kids, to adults with chronic medical illness, to obstetrics, etc.

Working more hours does not necessarily mean more pay. There are lots of hidden hours that you don't realize yet. Going over labs and consultant reports. Calling patients back after hours. Reading the latest journal articles. Doing home visits (if you are so inclined). Studies have shown that to take care of all your patients acute issues would take up 8 hours per day. To take care of all the preventive medicine for your patients would also take 8 hours per day. 16 hours a day is a bit rough. If you really want to go into primary care, there are lots of scholarship and loan payback programs out there.

There is monotony in every field you go into. Each specialty has patterns of patients that they see.
 
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Ineedhopenow

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I think I'm leaning towards rural family medicine now. I'm really interested in practicing full spectrum medicine and emphasize preventative care. I'm so excited! Thanks everyone :)

I've changed my mind so many times on which branch of medicine I want to be involved with. However I've always had a passion for preventative care and an interest in procedures. This might just be the perfect combo.
 

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I think I'm leaning towards rural family medicine now. I'm really interested in practicing full spectrum medicine and emphasize preventative care. I'm so excited! Thanks everyone :)

I've changed my mind so many times on which branch of medicine I want to be involved with. However I've always had a passion for preventative care and an interest in procedures. This might just be the perfect combo.

Take your time, soldier! You've got at least three years to firm up your residency choice, so try to take medical school one decision at a time until you need to consider your residency applications..
 

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What are some pros and cons besides the ones listed above for Internal Med vs Family Med nowadays?
 

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As an FYI, my PCP is an internist in private practice. He will do Pap Smears for women and some basic ob/gyn as well as do hormone work. My mentor is similar (hospitalist only), but will not touch hormone levels.

PCP before that was family (also in private practice) and refused to see kids, wouldn't do Pap Smears, but would write for hormones. I also shadowed a family doctor who was a traditional family doctor (worked for a hospital) and saw everything and I shadowed another (private practice) who would only see women and children.

The two areas have a lot of similarities and I suspect that there is a lot of freedom in what you actually see once you go into private practice.
 
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